Treat Stroke Victims for PTSD

A provocative new study suggests the recovery of some stroke victims, those who suffer brain hemorrhage, could be vastly improved if they were tested and treated for post-traumatic stress disorder.

A study of over 100 brain hemorrhage survivors found more than one third tested positive for the disorder, displaying symptoms such as painful memories and flashbacks of their hemorrhage, extreme anxiety and chronic fatigue.

Researchers found that post-traumatic stress disorder impacted greatly on the stroke patients’ recovery and their ability to resume a normal life, even if the actual brain damage caused by their type of stroke, called subarachnoid hemorrhage, was minor.

Strokes or cerebrovascular accidents are caused by lodging of a clot in brain vessels or a rupture and bleed from a cranial vessel. Although subarachnoid hemorrhage is a less common cause of stroke, the condition affects thousands of people each year.

The scientists say this type of stroke has a high cost for society because it afflicts much younger people than other types of stroke – most patients are around 55 – and a large proportion of these do not return to work following the hemorrhage.

Tests for post-traumatic stress disorder are currently not part of the usual care of subarachnoid haemorrhage victims.

But researchers say the findings of the study, published in the academic journal Neurosurgery, point to the need for greater awareness of the condition following a hemorrhage and early testing using simple questionnaires.

The findings could lead to significant improvements in the recovery of subarachnoid hemorrhage patients, according to the research team. They say doctors can identify those stroke victims most at risk by assessing how they deal with stress, with denial, self-distraction and self-blame as some of the key signs of ‘poor’ coping. These patients could be offered pre-emptive treatment to teach them effective coping strategies, say the scientists.

The team from Durham and Newcastle University, James Cook University Hospital in Middlesbrough and Newcastle General Hospital twice examined 105 patients who had suffered a subarachnoid hemorrhage, three months and thirteen months after their episode. Thirty seven per cent of the participants were diagnosed with post-traumatic stress disorder.

This is four times higher than the rate normally found in the general population and a similar level to that found in soldiers returning from war zones and amongst victims of sexual assault, say the scientists.

Post-traumatic stress disorder is a psychiatric condition that follows experience of a traumatic event which poses a threat to someone’s life or their physical integrity. In the case of subarachnoid bleeding, the researchers believe that many patients struggle to cope with the harrowing nature of their type of stroke – such as its spontaneous and extremely painful onset, the need to undergo invasive medical examinations, such as brain scans, lumbar puncture and surgery to the brain, as well as dealing with the fact that they have had a life-threatening illness.

Lead author Mr Adam Noble, a research assistant in Durham University’s Psychology Department said: “This is the first study to show the profound consequences which post-traumatic stress disorder has for patients who have suffered from a subarachnoid brain hemorrhage.

“It highlights a need to address this through more tailored treatment such as group therapy and, where possible, prevention through teaching patients more appropriate stress-coping strategies after they suffer a stroke.

“The findings could have wider implications for the treatment of neurological diseases in general. Brain damage is often seen as the cause of difficulties after a neurological illness but for all these conditions, psychological problems may well be a vital element in the patients’ poor recovery. This is something which needs further research.”

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Rick Nauert PhD

Dr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.